Resistance of Shigella strains to extended-spectrum cephalosporins in Isfahan province.

Background: The aim of this study was to determine the serotypes and antimicrobial susceptibility of Shigella spp. in Isfahan, (Iran) from 2010 to 2015. Methods: This retrospective study was conducted on Shigella isolates in four tertiary care hospitals. The process of bacterial isolation and determination of susceptibility was performed by standard microbiological guidelines. The patients were categorized into three age groups of under 5, 5-15 and over 15 years. Results: Among 45 isolates, S. sonnei (63.6%) was the predominant species, followed by S. flexneri (34.1%), and S. dysenteriae (2.3%). Substantial resistance to ampicillin, trimethoprim- sulfamethoxazole, ceftriaxone, cefotaxime, and cefixime was observed. Over 94% of the isolates were sensitive to ciprofloxacin. Susceptibility of isolates was similar between all age groups. Conclusion: Significant resistance to third generation cephalosporins precludes the use of these agents for empirical treatment of shigellosis in our population. Ciprofloxacin is an appropriate option; however, susceptibility tests should be performed before prescription.

The rate of antibiotic utilization in Iranian under 5-year-old children with acute respiratory tract illness: A nationwide community-based study.

BACKGROUND: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. MATERIALS AND METHODS: Data were collected from a national health survey conducted in 2010 (Iran's Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. RESULTS: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7% P < 0.05). CONCLUSION: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed.

Retroperitoneal abscess due to disseminated Bacille Calmette-Guérin infection.

Disseminated mycobacterial infection after Bacille Calmette-Guérin (BCG) vaccination is a rare disorder, usually presenting with fever, weight loss, anemia, lymphadenopathy and hepatosplenomegaly. We report a case of disseminated BCG infection in a 28-month-old girl with prolonged fever and abdominal mass due to retroperitoneal abscess. Appropriate therapy resulted in a good response. This is the second reported case of retroperitoneal abscess complicating BCG vaccination.

Antibiotic susceptibility patterns of isolates from children with urinary tract infection in Isfahan, Iran: Impact on empirical treatment.

OBJECTIVES: The aim of this study was to identify the antibiotic susceptibility of bacteria causing urinary tract infections (UTIs) in children in Isfahan, Iran. METHODS: Retrospective and prospective analyses were conducted on isolates from children with UTIs in a referral teaching hospital of Isfahan during 2013-2015. Findings were compared between first episode versus recurrent, nosocomial versus community-acquired, previous antibiotic use versus no previous antibiotic use, and febrile versus afebrile cases. RESULTS: Among 364 patients, 68.1% had no previous UTI, 19.7% has received antibiotics prior to infection and 96.2% were infected outside the hospital. Escherichia coli was the leading cause of UTI (68.1%), followed by Enterobacter (9.3%), Klebsiella (8.8%) and other bacteria (13.7%). Most isolates were relatively highly susceptible to imipenem (79.2%), ciprofloxacin (78.0%) and nitrofurantoin (70.8%), whereas sensitivity to cefotaxime (53%), cefalexin (39.8%) and trimethoprim/sulfamethoxazole (SXT) (26.1%) was low. Resistance to imipenem, cefotaxime and cefalexin was more prevalent in recurrent cases as well as in patients consuming antibiotics prior to UTI. Resistance of nosocomial cases to nitrofurantoin and cefotaxime was higher. In addition, afebrile patients had isolates that were more resistant to imipenem, ciprofloxacin and cefotaxime. Significant cross-resistance was found between most of the studied antibiotics. CONCLUSIONS: Urinary pathogens showed low susceptibility to cefalexin, SXT and cefotaxime and high susceptibility to imipenem, ciprofloxacin and nitrofurantoin. Therefore, use of imipenem and ciprofloxacin should be considered in hospitalised children with severe or complicated disease. In addition, nitrofurantoin is a good option in afebrile cases and for UTI chemoprophylaxis in this area.

Comparison of the Prevalence and Risk Factors of Hepatitis A in 10 to 18-Year-Old Adolescents of Sixteen Iranian Provinces: The CASPIAN-III Study.

BACKGROUND: Hepatitis A is a common health concern both in developing and developed countries. Hygienic and socioeconomic parameters deeply impact the prevalence and transmission of this disease. Evaluating the epidemiological distribution and risk factors for Hepatitis A virus (HAV) is necessary for policy makers to improve local and national preventive measures. OBJECTIVES: The aim of this study was to compare the prevalence of hepatitis A infection in a sample of Iranian adolescents living in different provinces of Iran and to assess its family- and community-related risk factors. METHODS: In this cross-sectional study, serum samples of 10 to 18-year-old adolescents, who were studied in a national health survey, were examined for anti-HAV antibodies. A total of 2,494 subjects were included from 16 provinces by multistage random cluster sampling. Demographic and socioeconomic factors related to HAV transmission were extracted by valid questionnaires. A multilevel analysis using mixed-effects logistic regression (melogit) was used to evaluate the association of risk factors with HAV infection. RESULTS: The weighted prevalence of HAV varied significantly across the studied provinces (P = 0.001), ranging from 50.43% in the Fars province to 78.81% in Markazi province. HAV was significantly more prevalent in children whose mothers worked outside of the home (OR, 1.73; 95% CI, 1.14-2.62; P = 0.009). CONCLUSIONS: The risk of symptomatic HAV infection is considerable in adolescents of all studied provinces; thus, universal HAV vaccination is recommended for all adolescents, regardless of their socioeconomic level. However, the risk is higher in some provinces, which seem to be transitioning from intermediate to low endemicity.

Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used. METHODS: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds. RESULTS: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU). CONCLUSION: According to results of this study, antibiotics' prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.

Persistence of endothelial cell damage late after Kawasaki disease in patients without coronary artery complications.

BACKGROUND: Recent studies proposed an increased risk of atherosclerosis in patients with a history of Kawasaki disease. This study aimed to investigate the persistence of vascular injury after an acute phase of the Kawasaki disease. MATERIALS AND METHODS: We determined the number of circulating endothelial cells (CEC) in the peripheral blood of 13 patients with a history of Kawasaki disease within four to ten years, in comparison with 13 healthy relative controls. The CECs were counted as CD146+/CD34 + cells by the standard flow cytometry technique, and the independent t-test was employed to compare the mean number of CECs in the two groups. RESULTS: The mean number of CECs was significantly higher in patients than in controls (12 ± 3.03 vs. 2.38 ± 0.87, respectively, P < 0.001). CONCLUSION: This study elucidates the persistence of vascular injury late after Kawasaki disease. This finding suggests that prolonged administration of vascular anti-inflammatory agents might be beneficial for preventing atherosclerosis in the subsequent years, in these patients.

Toxoplasma gondii infection in women of childbearing age of Isfahan, Iran: A population-based study.

BACKGROUND: We conducted an epidemiological survey on seroprevalence of toxoplasma infection in women of childbearing age in Isfahan Province. MATERIALS AND METHODS: In a cross-sectional study in 2010, 217 women in the age range of 10-50 years were randomly selected. The blood samples examined for the presence of IgG anti-Toxoplasma gondii antibody by a commercial ELISA kit (Dia-Pro, Milan, Italy). Chi-square and Fisher's exact tests were employed to examine the antibody status in different age, marriage, education, and residence groups. RESULTS: The overall prevalence was 47.5% (103/217). The peak age of infection acquisition was in the range 30-40 years in rural areas and 20-30 years in urban districts. There was no significant association between residence, education, and marriage groups on the one hand and chance of T. gondii infection on the other hand. CONCLUSIONS: The findings of the study suggest a moderate prevalence of T. gondii infection, but a high prevalence in ages of high reproductive activities.

Effect of corticosteroid therapy in esophageal stricture of a child with chronic granulomatous disease.

In chronic granulomatous disease (CGD) patients, esophageal stricture is a rare complication and the treatment of choice is still controversial. There are few reports of successful therapy with antibiotics, corticosteroids, multiple balloon dilatations or their combination.We report a 3-three-year-old Iranian boy with recurrent esophageal obstruction due to CGD. The patient transiently responded to dilatation in one occasion and at another time to short term steroid therapy. We observed an excellent response when long term and high dose of corticosteroid was administered. It showed that a long term and high dose steroid therapy is more effective than a short term in a patient with CGD and esophageal stricture.